First Name (*)

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Last Name (*)

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Street Address (*)

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City (*)

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State (*)

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ZIP code (*)

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Home Phone (*)

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Cell Phone

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Email (*)

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Are you over the age of 18? (*)
Yes No
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Do you own or rent your home? (*)
Own Rent
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If you rent your home, do you have permission to keep a dog?
Yes No
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How long have you lived at this address? (*)
Less than 1 year
1 to 2 years
3 to 5 years
6+ years

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Do you have an adequately fenced yard suitable for a Siberian Husky? (*)
Yes No
Invalid Input Adequate fencing means impenetrable.
Please describe your fenced in area or areas? (*)

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Do you plan to use crate training as a method? (*)
Yes No
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How many adults live in the household? (*)
1
2
3+

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How many children live in the household? (*)
None
1
2
3+

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Are any members of the household alergic to animals? (*)
Yes No
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If Yes, what animals are they allergic to?

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Please list names of all members of your family that will be responcible for your puppies care? (*)

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Where do you plan on keeping your Siberian Husky primarily? (*)
Inside
Outside
Both

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On average, how many hours per day will your Siberian Husky be left alone? (*)
1 to 5
6 to 10
10+

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Do you currently have a veterinarian? (*)
Yes No
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Name of your current veterinary clinic

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Phone number to clinic

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Will this puppy be your first purebred dog? (*)
Yes No
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Do you have any other dogs? (*)
Yes No
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Please list your other dogs name, breed, age, gender, neutered/spayed status, and weight. (*)
Name, breed, gender, age, neutered/spayed status, and weight.
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Check off any other animals in your household. (*)
Cat
Rabbit
Ferret
Mouse
Hamster
Other Small Animal
Reptile
Cattle
Horse
None

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How many dogs have you owned in the past 5 years? (*)
0
1
2
3+

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If you no longer have any/all of these dogs please describe why.

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Have you ever returned a pet to a breeder or taken an animal to a shelter? (*)
Yes No
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If Yes, please describe the circumstances.

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Please tell us in your own words why you chose this breed. (*)

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What activities do you plan on doing with your Husky? (*)
Jogging
Running
Walking
Obedience
Agility
Racing
Sledding
Weight Pulling
Conformation
Family Outings
Hiking
Camping
Swimming
None

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Any other activities not listed?

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Desired eye color for your Siberian Husky. (*)
Blue Eyes
Brown Eyes
Bi-Eyes
Parti-Eyes
Doesn't Matter

Invalid Input Bi-Eyes are when one eye is blue and one is brown. Parti-Eyes are when one or both of the eyes contain blue and brown in it\'s eyes.
Gender (*)
Male
Female
Doesn't Matter

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Color (*)
Black and White
Red and White
Brown and White
Gray and White
White
Agouti
Doesn't Matter

Invalid Input Please select all that apply? Agouti is a mixture of all colors: red, brown, gray, white, and black.
Other preferences?

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Is there a particular puppy available you are interested in?

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How did you find us? (*)
Referral
Internet Advertisement
Print Advertisement
Search Engine
Other

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Referred by or Other

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Do you understand that our puppies are made available as companions only. They are sold with Limited AKC Registration. You are obligated to spay/neuter your Siberian Husky by it\'s 8th month of age. Full Registration is available to selected individuals and there is an additional fee. (*)
Yes
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